Provider Demographics
NPI:1184031403
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:DAUGHTERS OF CHARITY HEALTH CENTER-GENTILLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-212-9502
Mailing Address - Street 1:PO BOX 13038
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70185-3038
Mailing Address - Country:US
Mailing Address - Phone:504-282-0089
Mailing Address - Fax:504-282-0338
Practice Address - Street 1:100 WARRINGTON DR.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-282-0089
Practice Address - Fax:504-282-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty